Racial and ethnic disparities in bronchiolitis management in freestanding children's hospitals

Honcoop, Aubree; Poitevien, Patricia; Kerns, Ellen; Alverson, Brian; McCulloh, Russell J.

doi:10.1111/acem.14274

Cited by 26 publications

(27 citation statements)

References 44 publications

(52 reference statements)

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“…Given that AP may disproportionately affect children of color, identifying current practices in managing pediatric AP based on these demographic factors is particularly important. Racial/ethnic disparities in management and outcomes have been reported in a variety of pediatric diseases and disorders (5)(6)(7)(8)(9) including surgical procedures such as pyloromyotomy (10) and resuscitation (11). Additionally, there are racial/ethnic disparities in mortality rates of adult pancreatitis patients (12).…”

Section: What Is Newmentioning

confidence: 99%

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Dike

Lyden

Quirós-Tejeira

et al. 2022

J. pediatr. gastroenterol. nutr.

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Objectives: Racial or ethnic disparities in health care delivery and resource utilization have been reported in a variety of pediatric diseases. In acute pancreatitis (AP), there is an association between Black race and increased inpatient mortality. Data on the association of race and ethnicity and resource use for managing pediatric AP are lacking. The aim of this study is to investigate this potential association in pediatric AP. Methods: Retrospective study of children 0-18 years diagnosed with AP in the Pediatric Health Information System (PHIS) database from 2012 to 2018. Descriptive statistics were used to summarize cohort characteristics. Race/ ethnicity classifications included non-Hispanic Black (NHB), non-Hispanic White (NHW, used as reference), Hispanic, and "Other." Associations between patient characteristics and race/ethnicity were determined using χ 2 tests. Generalized linear mixed regression model was used to determine the association of race/ethnicity with odds of resource utilization, costs, and length of hospital stay after adjusting for covariates with a random intercept for site. Results: Five thousand nine hundred sixty-three patients from 50 hospitals were included. Adjusted analysis showed that NHB children hospitalized with AP were at lower odds of receiving opioids in the first 24 hours [adjusted odds ratio (aOR) = 0.82, 95% confidence interval (CI) = 0.70-0.98] and receiving intravenous fluids during the hospitalization (aOR = 0.64, 95% CI = 0.43-0.96) when compared with NHW children. Additionally, NHB and Hispanic children had a prolonged adjusted mean length of hospital stay and higher hospital costs when compared with NHW children. Although there was no significant association between race/ethnicity and diagnosis of pancreatic necrosis or sepsis, Hispanic and "Other" children were at higher odds of receiving antibiotics during hospitalization for AP (aOR = 1.33, 95% CI = 1.13-1.57 and aOR = 1.37, 95% CI = 1.09-1.73, respectively) than NHW children. Conclusions: Disparities exist in utilization of health care interventions for pediatric AP patients by race/ethnicity. Future studies should investigate why these disparities exist and if these disparities affect outcomes.

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Section: What Is Newmentioning

confidence: 99%

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Dike

Lyden

Quirós-Tejeira

et al. 2022

J. pediatr. gastroenterol. nutr.

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“…As expected, the ED LOS and charges were both significantly higher for There is a theme the literature of increased testing and treatment for patients who identify as nHW compared to those from other race/ethnicity groups from several recent studies on pediatric ED disparities. These include more antibiotics for viral illnesses, 31 head imaging for minor head trauma, 32 and chest radiography for bronchiolitis 33 when they are not recommended. For pediatric migraine patients, there are also higher rates of inappropriate opioid prescriptions for patients who are nHW as a first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference

Hartford

Blume

Barry

et al. 2022

Academic Emergency Medicine

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Background: There are disparities in pain management for children presenting to the emergency department (ED) according to their racial and ethnic backgrounds. It is not known if there are differences in the treatment of pain associated with pediatric migraines by race, ethnicity, and language for care (REaL). Methods:We analyzed treatment patterns and outcomes in our ED for acute migraine in pediatric patients by REaL. Retrospective data on treatments, length of stay (LOS), and charges were collected from the electronic medical record for pediatric patients on the ED migraine pathway from October 2016 to February 2020. Patient race/ ethnicity and language for care were self-reported at registration. We analyzed two treatment groups: receipt of oral (PO) or intranasal (IN) medications only or intravenous (IV) ± IN/PO medications. A total of 833 patients (median age 14.8 years, interquartile range [IQR] 12.3-16.5 years; 67% female, 51% non-Hispanic White (nHW), 23% Hispanic, 8.3% Black or African American, 4.3% Asian) were included. A total of 287 received PO/IN medications only and 546 received IV medications.Results: Initial pain scores in the two groups were similar. Patients who were Asian, Black or African American, and Hispanic or had a language for care other than English (LOE) had significantly lower odds of receiving IV treatment, while patients who were nHW and preferred English had higher odds of receiving IV treatment. The IV treatment group had longer LOS and ED charges. Pediatric ED patients with migraine who were Black, Asian, and Hispanic or had a LOE had a decreased likelihood of receiving IV therapies while patients who were nHW were more likely to receive IV treatments, despite similar initial pain scores.Conclusions: These data align with previous studies on pain management disparities and highlight another area where we must improve equity for patients in the ED.

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“…Demographic covariates of interest were chosen based on reported impact on resource utilization or outcomes including age, 11 sex, 11 race/ethnicity, 12 payor, 9 rurality (Rural‐Urban Commuting Area [RUCA] Code of the patient's zip code) 13 . Clinical covariates included season of presentation (as defined by the National Oceanic and Atmospheric Administration) 14,15 and highest respiratory support on Day 1 of their ICU stay.…”

Section: Methodsmentioning

confidence: 99%

Antibiotic use in nonintubated children with bronchiolitis in the intensive care unit

Ortmann

Nabower

Cullimore

et al. 2022

Pediatric Pulmonology

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Introduction Antibiotic use may shorten mechanical ventilation duration and length of stay for patients with bronchiolitis that require intubation. The goals of this study were to describe antibiotic use in previously healthy children with bronchiolitis admitted to the intensive care unit (ICU) for noninvasive respiratory support and to describe associations of early antibiotic use with clinical outcomes. Methods The Pediatric Health Information Systems database was queried for children <2 years of age without significant comorbidities admitted to the ICU for bronchiolitis. Children requiring mechanical ventilation on the first ICU day were excluded. Two groups were analyzed: those patients receiving antibiotics on the first day of their ICU stay (early antibiotics), and those receiving no antibiotics on their first ICU day (no antibiotics). Primary outcome was the length of ICU stay. Results A total of 11,029 admissions met criteria, 2522 (22.9%) in the early antibiotic group, and 8507 (77.1%) in the no antibiotic group. The use of early antibiotics varied by center from 10% to 54%. In multivariate analysis, the early antibiotic group had similar ICU length of stay compared to the no antibiotic group (relative risk, RR [95% confidence interval, CI] 1.01 [0.98–1.05]). For patients on noninvasive ventilation, the first ICU day early antibiotics did not impact ICU length of stay (RR [95% CI] 0.97 [0.92–1.02]) or need for intubation (RR [95% CI] 1.11 [0.77–1.58]). Conclusion Early antibiotic use was common with significant variation between centers. Early antibiotic use was not associated with improved clinical outcomes in children admitted to the ICU for noninvasive respiratory support for bronchiolitis.

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Racial and ethnic disparities in bronchiolitis management in freestanding children's hospitals

Cited by 26 publications

References 44 publications

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Racial/Ethnic Disparities in the Management of Pediatric Acute Pancreatitis Across Children’s Hospitals

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference

Antibiotic use in nonintubated children with bronchiolitis in the intensive care unit

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